Extreme hypernatraemia and rhabdomyolysis in a child with hyperosmolar hyperglycaemic state mixed with diabetic ketoacidosis

Abstract

Abstract Diabetic ketoacidosis (DKA) is present at diagnosis for about 40% of children with type 1 diabetes mellitus (DM).1 Hyperosmolar hyperglycaemic state (HHS) is another acute complication of DM more typically associated with type 2 DM in adults or adolescents. Recent evidence indicates that a mixed picture of HHS and DKA also occurs in children with type 1 DM2 but it is not frequently reported and therefore at risk of under‐recognition.Here, we report a rare case of HHS mixed with DKA as the first presentation for type 1 DM in a five‐year‐old child with underlying neurodevelopmental problems. Failure to recognise the HHS aspects led to severe hypernatraemia, hyperosmolarity, acute renal impairment and rhabdomyolysis but ultimately the child made a full recovery. This case highlights the importance of early recognition and potential pitfalls in management of mixed HHS with type 1 DM. Copyright © 2023 John Wiley & Sons.